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Editor’s Note: The new coronavirus disease known as COVID-19 continues to spread in the United States and around the world. The number of cases has surpassed 2,000 in the U.S. and 145,000 worldwide. Cancer Health has covered the latest news on COVID-19 and will continue to do so.
Although older people, those with other health conditions and people with compromised immune systems remain most at risk of severe illness from the new coronavirus, everyone should be vigilant.
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A month after the new coronavirus respiratory disease known as COVID-19 came to public attention, researchers and public health officials are continuing to learn about its spread, its mortality rate and who is most likely to become seriously ill.
Although much remains unknown, it’s clear that elderly people, those with other health conditions and people with compromised immune systems have a higher likelihood of severe illness. This includes people with cancer who are being treated with chemotherapy. But taking some basic precautions can lower your risk and improve your well-being.
As of March 2, there were 43 confirmed or presumed positive cases of COVID-19 detected in the United States, according to the Centers for Disease Control and Prevention (CDC). In addition, there have been 48 cases among people brought back to the United States, mostly from the Diamond Princess cruise ship. The virus now appears to be spreading locally within communities. Worldwide, more than 87,000 cases have been reported, according to the World Health Organization. Most of these are in China, but 58 countries have now seen cases.
The mortality rate for COVID-19 is thought to be around 2.5%, based on the numbers reported in the hardest-hit areas of China. This is substantially higher than the typical seasonal flu (around 0.1%) but much lower than the death rates of the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) coronaviruses, at around 10% and 30%, respectively.
However, the true COVID-19 mortality rate is not yet known because it is unclear how many people have contracted the new virus. If a large number of people have no or mild symptoms and never seek medical attention, the pool of infected people could be much larger, and the death rate could be much lower. Receiving supportive treatment earlier in the course of the disease also lowers the risk of death.
A majority of people with COVID-19 have mild symptoms, including fever, cough and shortness of breath. Around 20% develop more severe illness, including pneumonia and acute respiratory distress syndrome, which may require intensive care and in some cases mechanical ventilation.
But not everyone who contracts the virus is at equal risk. According to a recent study of 45,000 confirmed cases by the Chinese Center for Disease Control and Prevention, people with cancer, cardiovascular disease, diabetes, chronic respiratory disease and high blood pressure had a higher rate of death. The greatest risk was seen among people age 80 or older, at 14.8%.
Experts do not yet know how long someone can transmit the coronavirus, officially known as SARS-CoV-2, before they develop symptoms or after they recover. It is also unclear whether the virus can linger in the body and later relapse; whether it confers immunity and, if so, for how long; or what the likelihood is of becoming infected again.
Researchers are hard at work to develop treatments for COVID-19 and a vaccine for SARS-CoV-2. Certain HIV medications have shown activity against the coronavirus. Clinical trials of Gilead Sciences’ antiviral drug remdesivir are currently underway in China and at the University of Nebraska Medical Center in Omaha—home of the CDC’s largest biocontainment unit—where some people who contracted the virus overseas are being treated. A vaccine from Moderna Therapeutics has been sent to the National Institute of Allergy and Infectious Diseases for the first Phase I study. However, human trials are expected to last at least a year before a vaccine is ready for widespread use.
What About People With Cancer?
Compared with the general population, people with cancer are at higher risk of developing more serious COVID-19 illness. As a group, they are older and have poorer overall health, and many are taking medications that suppress the immune system. In the study cited above, people with cancer had a death rate of 5.6%—more than twice as high as the overall estimated COVID-19 mortality rate.
Editor’s note: An earlier version of this article stated that people with compromised immunity are at greater risk of contracting the coronavirus, in addition to developing more serious disease. While this is the case for many infections, there currently are not enough data to say whether immunocompromised people, including those living with cancer, are at greater risk of catching the new virus.
Many chemotherapy medications and targeted therapies for cancer can cause neutropenia, or depletion of immune system white blood cells that fight infection. People who receive CAR-T therapy or bone marrow stem cell transplants for leukemia or lymphoma usually receive strong chemotherapy to kill off their cancerous blood cells and make room for the new ones, which leaves them vulnerable to infections.
“When you look at who’s been most profoundly ill, it tends to be people who are older, in their 60s, 70s and 80s,” says Steve Pergam, MD, MPH, of the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center. “As you get older, your immune system doesn’t function as well. In cancer patients on chemotherapy, people with solid organ transplants or bone marrow transplants and those who use high-dose steroids for autoimmune diseases, the risk will likely be more severe. They may shed the virus for longer. They may be more likely to develop pneumonia and more likely to die. We don’t know until we have more information, but many of us have concerns about that.”
People with a weakened immune system may be unable to fight off the virus, or they may develop an abnormal excessive immune response known as a cytokine storm. Paradoxically, immune suppression can sometimes mean milder early symptoms, such as fever, even as the virus and the body’s response to it ravage the lungs.
“With other respiratory viruses, immune-suppressed patients often don’t present with the classical symptoms,” Pergam told Cancer Health. “The symptoms may be more subtle, so we have to have more awareness. Oftentimes their initial symptoms may be less prominent, but the level of complex disease may be more severe.”
Another Chinese study, reported in Lancet Oncology, analyzed data from 1,590 people with confirmed COVID-19 at 575 hospitals. This group included 18 people with cancer, “which seems to be higher than the incidence of cancer in the overall Chinese population,” according to the study authors.
Four of the 16 patients with a known treatment status had received chemotherapy or surgery within the past month, while the other 12 were cancer survivors undergoing routine follow-up. COVID-19 patients with cancer were older on average (63 versus 49 years), more likely to be current or former smokers, more likely to experience rapid breathing and had more abnormal lung CT scans than those without cancer.
What’s more, seven of the cancer patients (39%) had severe disease, defined as either admission to an intensive care unit for mechanical ventilation or death, than those without cancer (8%). Three of the four people (75%) who had received recent chemotherapy or surgery developed severe disease, compared with six of the 14 people (43%) not recently treated for cancer.
The researchers suggested that during the COVID-19 crisis, people who have stable cancer in areas where the coronavirus is common might consider postponing chemotherapy or elective surgery. But so far there is no reason for people in the United States to defer cancer treatment. They also recommended stronger personal protection provisions for cancer patients and survivors and more intensive surveillance and treatment, especially for older individuals and those with other health conditions.
Experts recommend that everyone take common-sense precautions to prevent transmission of the new coronavirus—the same ones recommended to prevent seasonal flu:
- Avoid close contact—meaning within about six feet—with people who have a cough or other respiratory symptoms.
- Wash your hands with soap and water thoroughly and often for at least 20 seconds.
- Use alcohol-based hand sanitizer when soap and water are unavailable.
- Avoid touching your eyes, nose and mouth.
- Healthy people do not need to routinely wear face masks to prevent infection, but use a mask if you are caring for someone who is ill.
- Get the flu vaccine. Older people should also consider getting vaccinated against pneumonia.
If you are ill:
- Cough or sneeze into a tissue or your elbow, and immediately dispose of tissues in the trash.
- Avoid close contact with others.
- Stay home if you are sick.
- If you think you may have been exposed to the coronavirus, contact a health care provider promptly if you develop a fever, cough or difficulty breathing.
- Before you go to a clinic or hospital, call ahead so the staff can take appropriate precautions.
- Wearing a face mask can stop the spread of droplets that can transmit the virus to others.
“I advise people to have hand sanitizer wherever they go and use it frequently in public places—I have it in my pocket all the time,” Pergam advises. “Wash your hands with soap and water long enough to sing the ’Happy Birthday’ song.”
People living with cancer may benefit from extra precautions.
“I always talk with patients about the idea of social distancing. I’m not saying you can’t live your life as a normal person. But you don’t have to go out to dinner when a restaurant is super crowded—you might eat a little earlier or you might order in,” he continues. “If you’re having friends or family over, ask them if they have any symptoms. Have a hand gel dispenser at your front door, and make sure everybody uses it. Tell friends and family that they should be up to date on their vaccines for other things.”
People who need prescription medications should try to have a supply to last at least a couple of weeks and preferably a few months. Shortages could happen because the ingredients for many drugs—especially generics—are produced in China. Pergam acknowledges that this can be difficult because of cost and insurance restrictions. You may be able to order medications for three months at a time. Or renew your prescriptions as soon as you are able to—even if they haven’t run out yet—so you have a buffer of several days.
The Food and Drug Administration is keeping track of medication shortages that may result from the epidemic. According to a recent statement, only one unspecified drug is now in short supply. No biological agents, such monoclonal antibodies or gene therapies, are made in China for the U.S. market, and there are no shortages.
It’s also a good idea to have at least a two-week supply of food, water, cleaning supplies and other household necessities on hand. And don’t forget to stock up on pet food. You may be able to have goods delivered to avoid going to stores. Or ask a friend or family member without compromised immunity for help.
As the COVID-19 outbreak becomes more widespread, “disruption to everyday life might be severe,” according to Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, who advises businesses to explore remote work options and families to consider plans in case schools close.
“Consider what’s going to happen for someone who’s undergoing treatment if kids are kept home from school or if businesses are affected,” Pergam advises. “If you have cancer or an immunosuppressive condition, talk to your employer about opportunities to work from home. And have them remind everyone you work with not to come to work sick.”
Stay in communication with your cancer team, and keep up to date on new developments. Let them know if you have questions or concerns, especially if you have new symptoms or were recently exposed to someone who is ill.
“The biggest thing to get across is, don’t panic,” Pergam says. "We’re all expecting this to be a prolonged and complicated process. The best thing people can do is focus on ways that they can protect themselves because those small things can be enough to provide an extra layer of protection for everyone.